Dialectical Behaviour Therapy for ADHD

Last meeting, we talked about DBT as a burgeoning therapy for treating ADHD in both children and adults. DBT stands for Dialectical Behaviour Therapy and was devised by Marsha Lenehan as a therapy for Borderline Personality Disorder. But its its concepts and skillsets are so useful and applicable to anyone that, in recent years, it has been adapted to help other types of disorders, including ADHD. Both ADHD and BPD share many of the same symptoms such as emotional control, interpersonal communication and issues of focus. In my opinion, Dialectical Behaviour Therapy is useful for anyone to learn, whether you have been diagnosed with anything or not.

Let’s just cover some of the basic concepts of DBT.

What is a Dialectic?

A ‘dialectic’ is a form of discussion which dates back to ancient Greece. It is a way of resolving a conflict between two or more people. It was determined by its conceptualizers that often emotional disregulation and unwarranted judgement stood in the way of people reaching viable or reasonable solutions to problems to the detriment of everyone. So dialectics was utilized as a way of seeing past one’s perceived limitations or barriers to see the other person’s point of view and to mutually reach the ‘truth’ of the situation. Such schools of thought are also prevalent in eastern cultures such as Buddhism and Hinduism.

Dialectical Behaviour Therapy draws on the core principles of the dialectic approach in order to help people identify, understand and alter their own patterns of thought — to see more than one side of a situation, to empathize and understand the positions of others and to work toward achieving more open-mindedness and wisdom in their daily life.

DBT’s Concepts

There are four areas of DBT to explore. The first is the Mindfulness component. Mindfulness is a phrase that has been more and more prevalent in the mainstream over the last decade due to the success of DBT as a whole. However, many users of this term tend not to cover its deeper meaning and practice as it relates to personal growth. Mindfulness is not concentration, nor is is meditation. What it is is living in the moment. It is the practise of doing one thing at a time and doing only that one thing. It is taking in all the elements of that moment, the sights, sounds, smells, tastes and tactile information that go with it. And it is the ability to allow any non-related or non-important thoughts or distractions pass by you. In short, it is being ‘present’.

Mindfulness, contrary to what the mainstream consciousness may imply, is not an easy thing to learn. For many of us, we are well practised in our habits of thought and deed — being easily distracted, worrying about the past or the future, having ‘baggage’ which interferes with our emotional health; all of these things and more take us away from the present moment and can obstruct our ability to really know and understand what’s happening to us in the present. Mindfulness is a practise that gradually teaches us to do just that. It requires patience and dedication.


DBT teaches skillsets designed to understand mindfulness and how to achieve it. You will understand the difference between Emotion Mind, Reasonable Mind and Wise Mind.

Wise Mind is the state we most want to be in. It is the balance between the other two states and allows you to make the best decision in any given situation.

Observe, Describe and Participate

These are called the What Skills. You are already doing these three things every day of your life since you were born. But you have been likely doing them so rapidly that they seem to be one process. The mindfulness component aims to slow this process down so that you may be able to change it.

  • Observe: This is when your brain takes in data from your five senses. It is simply the facts of your surroundings as they are.
  • Describe: This is how your brain will take that data and link it to something it already knows.
  • Participate: This is how you will determine what actions to take once you have determined what is happening.

The brain is designed to judge things and look for patterns. This is one of its core functions. However, not every brain is alike. Each personality with a different life and history may see things differently. See the following example:

  • Observe: While driving, someone cuts you off on the highway.
  • Describe: Some jerk just cut me off!
  • Participate: You flip him the bird and curse him out.

In this situation, you probably went through all three stages very quickly. You’re brain determined that anyone who cuts you off must be a jerk and you participated by getting angry and recoiling back at the other person. But let’s look at the consequences of that decision.

Now that you have been cut off, you are angry and anger is an emotion that stays inside of you. The other person is already driving away from you and likely doesn’t care that you are angry at him. So you are carrying that around with you now and it will tend to affect the rest of your drive, perhaps even the rest of your day.

Dialectics suggests that another way to handle this situation is this:

  • Observe: While driving, someone cuts you off on the highway.
  • Describe: A car just swerved in front of me.
  • Participate: You gently apply the brakes so as not to collide with him and continue driving.

In this variation, you have observed the same thing, but your description was based on the facts of the situation instead of a judgement. Therefore, your participation was different and you are not burdened with anger.

The ability to use and practise the What Skills are what the How Skills are for.

  • Non-Judgemental: sticking to the facts and not your interpretations of what you observe.
  • One-Mindfully: doing one thing at a time in the present moment.
  • Effectiveness: Doing what works.

There is much more to this component which I will get into in the lessons, but you can see how the Mindfulness module is absolutely key to everything else you will learn in DBT.

Other Components

DBT includes three further sections which build upon the first one. Each addresses a different element of a person’s life and personality.

Distress Tolerance
ADDers often have difficulty tolerating distress — and they may have an exaggerated idea of what is distress compared to non-ADDers. This module teaches you how to tolerate and endure any number of stressful and difficult situations – anything from niggly pet peeves like too much noise or waiting in line to more dire circumstances like losing your job to the death of a loved one. It focuses on skills such as Acceptance, Radical Acceptance and Self-Soothing. 

Emotion Regulation
ADDers have often been described as emotionally ‘immature’ or have difficulty managing feelings when things get rough. Here you will learn how to identify and manage your emotions, and you will also learn specific skills to reduce your vulnerability to emotions. Skills such as Building Mastery, Problem Solving and Letting Go are covered here.

Interpersonal Effectiveness
This is an important module that teaches one the skills needed to navigate numerous types of situations involving themselves and others. ADDers sometimes have social issues relating to how they were treated during their life. We often agree to things that we don’t want to do, or are unable to ask for things we need from others. So here is where we learn very necessary skills to ensure there is balance in how we interact with others while Keeping Self-Respect, Being Confident and Sticking to our Values. 


It is my intention to start a free DBT subgroup for anyone who is interested in learning DBT more in depth. This will probably be an ‘eGroup’, meaning that we will work through the material through a series of videos and email. Anyone who is interested can email me at adhdokhamilton@gmail.com and we will get it going. 🙂

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